Stable, unstable elbow dislocations may benefit from non-surgical treatment

Michael D. McKee, MD, FRCS(C)

This interesting presentation by Joseph A. Abboud, MD, confirms many of the conventional beliefs that most cases of simple elbow dislocation can be treated non-surgically. Since the 1980s, when randomized trials showed that there was no consistent surgical benefit from open repair of ligamentous injuries from isolated or simple elbow dislocations, the standard of care has been closed reduction and early motion.

As Abboud points out, many of these individuals will have significant lateral deformity, but an intact medial collateral ligament and, in those individuals, pronation of the forearm helps keep the elbow reduced. If a simple elbow dislocation (ie without associated fractures) shows early instability (redislocation or unacceptable subluxation), then surgical repair is usually indicated rather than re-reduction and prolonged immobilization. Surgical repair in this setting usually targets the lateral structures. As Abboud also points out, a CT scan is an excellent way not only to demonstrate associated fractures (an elbow fracture/dislocation has a higher requirement for surgical intervention), but also to assess for joint congruence.

Michael D. McKee, MD, FRCS(C)

Professor and Chair, Orthopedic Surgery Department

University of Arizona College of Medicine – Phoenix

phoenix

Orthopedics Today Editor

disclosures: McKee reports that he is a consultant for Stryker.

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